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The Pragmatic Removal of Penicillin Allergy Electronic Health Record Labels (PROPEL) Trial: A Randomized Clinical Trial
Journal article   Open access   Peer reviewed

The Pragmatic Removal of Penicillin Allergy Electronic Health Record Labels (PROPEL) Trial: A Randomized Clinical Trial

Cosby A. Stone, Heather L. Prigmore, Allison B. McCoy, Joanna L. Stollings, Mary Lynn Dear, William Hiser, Grace Van Winkle, Sunil Kripalani, Adam Wright, Frank E. Harrell, …
The journal of allergy and clinical immunology in practice (Cambridge, MA), Vol.13(10), pp.2747-2755
2025
DOI: https://doi.org/10.1016/j.jaip.2025.07.006
PMID: 40675326
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Published881.16 kBDownloadView
CC BY-NC-ND V4.0,  Open Access

Abstract

Allergy De-labeling Hospital Implementation Inpatient Penicillin Pharmacist RCT Trial
Inaccurate penicillin allergy labels (PALs) affect antimicrobial stewardship, health outcomes, and costs. More than 95% of PALs can be de-labeled when tested, but this rarely happens. We sought to determine whether education and an electronic health record (EHR) tool kit to identify low-risk PALs would facilitate inpatient penicillin allergy de-labeling by pharmacists. Pragmatic Removal of Penicillin Allergy Electronic Health Record Labels was a stepped-wedge, nonblinded, randomized, controlled, pragmatic clinical trial including 12 inpatient medical units. From November 2020 to November 2021, units entered intervention at 1-month stepped intervals in random order. Medically stable, nonpregnant adults with an her-documented PAL who were hospitalized on intervention units for 24 hours were included. The intervention included pharmacist and nursing education, a patient list for systematic identification of PALs, presentation of a risk-assessment tool, and an oral amoxicillin challenge order set. The primary outcome was removal of PAL by hospital discharge. Secondary outcomes included safety and implementation measures, longer-term continued label removal, and antibiotic use. On 12 randomized units, 2,052 patients with a PAL presented during the 1-year trial. More intervention-exposed patients had EHR-documented penicillin allergy removal compared with controls (45 of 1,018 [4.4%] vs 31 of 1,034 [3%], respectively; adjusted odds ratio = 2.05; 95% CI, 1.08-3.91). More intervention-exposed patients received an EHR-documented penicillin allergy risk assessment than did controls (86 of 1,018 [8.4%] vs 27 of 1,034 [2.6%]; adjusted odds ratio = 6.42; 95% CI, 3.08-13.38). Moreover, 27 of 1,018 intervention patients (2.7%) received amoxicillin challenge compared with 21 of 1,034 control patients (2.0%). All amoxicillin challenges were tolerated. Education and deployment of an inpatient EHR tool kit increased the rate of inpatient removal of inaccurate penicillin allergies before discharge.

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Collaboration types
Domestic collaboration
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Citation topics
1 Clinical & Life Sciences
1.265 Dermatology - Skin Allergies
1.265.1140 Drug Hypersensitivity
Web Of Science research areas
Allergy
Immunology
ESI research areas
Clinical Medicine
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